Original ReportsReadiness of Graduating General Surgery Residents to Perform Colorectal Procedures
Introduction
Traditionally, the goal of surgical residency has been to prepare residents to practice surgery independently.1,2 However, work hour limitations and expectations of faculty supervision may threaten residents’ maturation in many domains, including technical skill.3 National survey studies find that residents, residency program directors, and fellowship directors have concerns that graduating residents are unprepared to operate without supervision.4, 5, 6 These opinions are corroborated by a previous population-based study that specifically examined residents’ technical performance, as rated by attendings, in general surgery procedures.7 This study analyzed 10,130 ratings of 536 categorical general surgery residents, and found that residents are not universally ready to independently perform procedures defined as “core” by the American Board of Surgery (ABS).8 Perhaps as a result, the majority of general surgery residents choose to enter specialty fellowship training.9, 10, 11, 12
Because the demand for colorectal operations across the US exceeds the supply of fellowship trained colon and rectal surgeons, most of these operations are still performed by general surgeons.13 Population-based studies show that general surgeons perform 69% of anorectal procedures, 77% of proctectomies, 88% of colectomies, and 94% of urgent or emergent colectomies for diverticulitis.14,15 Yet, there are no detailed studies that evaluate general surgery residents’ preparedness in colorectal procedures without fellowship training. It is unknown whether there are differences in level of preparedness between common operations, such as colectomy, and more complicated operations, such as abdominoperineal proctectomy. Quantifying residents’ proficiency in these procedures can identify training gaps and define the necessity for advanced training in colon and rectal surgery.
In this study, we analyzed attending ratings of graduating general surgery residents’ performance and autonomy after a variety of colorectal surgery procedures. Those analyses were done in reference to the ABS taxonomy for surgical procedures, which divides procedures into core (e.g., partial colectomy) and advanced (e.g., abdominoperineal resection, or APR). We hypothesized that resident performance would be rated lower in advanced procedures compared to core procedures. Similarly, we hypothesized that resident autonomy would be rated lower in advanced procedures.
Section snippets
Overview
This study was reviewed by the University of Michigan Institutional Review Board and deemed Not Regulated. We used data from the Procedural Learning and Safety Collaborative (PLSC), a national surgical education quality improvement collaborative that investigates and develops tools to improve surgical learning and training. As part of a multi-institution observational study, the PLSC collected general surgery attending and resident ratings of a resident's technical performance after completing
Subjects and Procedures
This study included 2102 rated colorectal cases for 564 general surgery residents, rated by a total of 306 attendings from September 2015 to September 2018 (Table 3). Residents included this study were from 30 programs; 9 (30%) of these programs had a dedicated colon and rectal surgery residency. Out of the 30 programs, 25 (83%) were university-based, 1 (3%) was a community program, and 4 (13%) were community-based but university-affiliated. The mean (SD) number of residents per class was 7
Discussion
This study had 2 main findings. First, general surgery residents were not universally considered ready to perform colorectal operations independently in the last year of their residency. Second, competency gaps were particularly pronounced for advanced colorectal operations, such as LAR or APR. After adjusting for rater factors and other confounding variables, a graduating general surgery resident had a 93% probability of having competent performance in a core procedure, but only a 75%
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General Surgery Residents’ Retention of Knowledge After an Anorectal Skills Workshop
2022, Journal of Surgical ResearchCitation Excerpt :Previous literature has demonstrated the subpar education that most general surgery residents receive, and the subsequent lack of comfort that many graduating residents have with this area of practice is well documented.1,4,11 Within general surgery programs, not all residents are rated proficient at common anorectal procedures by the time of graduation.12 Although many general surgery residency programs have skills curriculum, the frequency of anorectal pathology sessions is unknown.
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Funding: JVV: National Institute of Diabetes and Digestive and Kidney Diseases, 1F32DK115340-01A1. BCG: University of Michigan Graduate Medical Education Innovations Fund. SJR: National Institutes of Health 5T32DK108740. SER: National Institute on Aging, K08AG047252.
Disclosures: The authors have no conflicts of interest to report.